PRODUCT / PROCESS CHANGE NOTIFICATION

Complete this form and email to your customer organization whenever customer notification is required by the PPAP
Manual in Table 3.1. Your customer will respond back with an acknowledgement and may request additional change
clarification or PPAP submission requirements.

To: Customer:

Organization Part Number: Engineering Revision Level: Dated:

Customer Part Number: Engineering Revision Level: Dated:

Purchase Order Number: Safety and/or government regulation:

Application:

ORGANIZATION MANUFACTURING INFORMATION

Name: Code:
Street Address:
City, State & Zip: Change Type (check all that apply)

Dimensional
Customer Plants Affected: Materials
Functional
Design Responsibility: Customer Organization Appearance

Organization Change That May Affect End Item:

Product Change Engineering Drawing Change New or Revised Subcomponent

Expected PPAP Completion/Submission Date:

DETAILED DESCRIPTION OF PRODUCT/PROCESS CHANGE:

Plannned Date of Implemenation:

DECLARATION:
I hereby certify that representative samples will be manufactured using the revised product and/or process and verified,
where appropriate, for dimensional change, appearance change, physical property change, functionally for performance
and durability. I also certify that documented evidnce of such compliance is on file and available for customer review.

Explantion/Comments:

NAME: TITLE:

BUSINESS PHONE NO: FAX NO:

E-MAIL: DATE:
NOTE: Please submit this notification at least 6 weeks prior to the planned change implementation!

Contact your customer to determine if this form is available in an electronic format or if this form should be faxed.
March
2006 THE-1002